Use of omentum pedicled graft to protect great vessels in gastric transposition for pharyngoesophageal cancer

Background and Objectives: Transmediastinal gastric transposition and pharyngogastric anastomosis is perhaps one of the most widely accepted methods for restoration of the alimentary continuity after pharyngoesophageal resection. The need of neck dissection, mediastinal tracheostomy, and previous radiotherapy may favor exposure and rupture of major vessels. Protection with omentum may prevent this complication. A comprehensive review of omentum flap use in surgery was undertaken. Methods: A modified omentum pedicled flap was used in 6 out of 36 patients submitted to total pharyngolaryngoesophagectomy and gastric transposition (PLE&GT). Results: None of the patients had major vessel rupture as compared with a 13% carotid and innominate artery rupture of a series of 30 patients previously operated on without omentum pedicled flap protection. Conclusions: The omental pedicled flap, performed as described, may provide reliable protection for carotid and innominate artery exposure, adding little time to the procedure. J. Surg. Oncol. 1999;70:181-184. (C) 1999 Wiley-Liss, Inc.70318118

Regression of childhood Barrett's esophageal mucosa by antireflux surgery and bipolar electrocoagulation

The authors report a case of a 13-year-old girl with Barrett's esophagus who underwent antireflux surgery and was subsequently treated with endoscopic thermal coagulation using bipolar electrocoagulation. Follow-up endoscopy 15 months after completion of the endoscopic therapy showed normal esophageal mucosa without intestinal metaplasia. Longer follow-up is needed to assess the long-term effects of endoscopic treatment of the Barrett's mucosa with thermal coagulation, and this procedure should still be considered under investigation. Copyright (C) 1998 by W.B. Saunders Company.33574774

Bladder Autoaugmentation in Dogs: Assessment of Different Laparoscopic Methods

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Purpose: Bladder autoaugmentation was described in 1989, and the effectiveness of this surgical technique in the management of neurogenic bladder dysfunctions is still debated. Few experimental studies with different animals and diverse changes in technique have been described, making comparison of studies difficult. The aim of this study was to assess laparoscopic bladder autoaugmentation in dogs, allowing future studies to be developed using a uniform surgical technique and the results to be compared. Materials and Methods: Seven male mongrel dogs weighing from 15 to 20 kg under general anesthesia underwent urodynamic evaluation. Laparoscopic bladder autoaugmentation was then attempted either with or without the use of the intravesical silicone balloon. Results: The reproduction of the open technique caused complications. Changing the method of dissection was essential for completing the surgery. As different limitations appeared solutions were found as well. The use of the intravesical balloon requires the surgery to be different, although quite similar. Conclusions: Laparoscopic bladder autoaugmentation is feasible in the canine model with and without the intravesical silicone balloon. The best way to perform the surgery was identified for both methods. Future studies can be developed using a uniform surgical technique, and the functional results will be comparable.o TEXTO COMPLETO DESTE ARTIGO, ESTARÁ DISPONÍVEL À PARTIR DE AGOSTO DE 2015.234699703Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

A videolaparoscopia no diagnóstico e tratamento do schwannoma abdominal

The authors present two patients with solid tumours (benign Schwannoma), which were found during abdominal ultra-sonography. One of them was located adjacent to the hepatic artery, near its origin at the celiac axis. In the second case the tumor was found in the diafragm. Both of them were well limited and non-invasive (benign characteristics). The removal -for diagnosis and treatment - was done using videolaparoscopy. They emphasize the huge advantages of this new diagnostic and therapeutical modality

O esôfago de Barrett associado à estenose cáustica do esôfago Barrett's esophagus associated to caustic stenosis of the esophagus

RACIONAL: A estenose esofágica secundária à ingestão de produtos cáusticos é freqüente no Brasil, principalmente como tentativa de suicídio. O esôfago de Barrett surge como conseqüência do refluxo gastroesofágico crônico. A literatura pesquisada mostrou que esta associação é muito rara. CASUÍSTICA E MÉTODOS: De 1981 a 2000 foram admitidos e tratados no Gastrocentro-UNICAMP (Universidade Estadual de Campinas, SP.) 120 doentes com estenose cáustica do esôfago e durante o seguimento destes, foram encontrados 9 casos associados com o esôfago de Barrett (7,5%). O tempo de ingestão do cáustico variou de 4 a 54 anos (média de 29 anos) e eram quatro homens e cinco mulheres, oito brancos e um negro, com idade média de 57,7 anos (43 a 72 anos). RESULTADOS: Todos os casos apresentavam disfagia e a endoscopia digestiva alta flexível mostrou áreas de estenose e seqüelas de esofagite cáustica. Três pacientes referiram sintomas de refluxo gastroesofágico, mas hérnia de hiato foi encontrada em apenas um caso. O esôfago de Barrett foi encontrado no terço médio do esôfago em três casos, acima das áreas de estenose, e nos demais, no terço distal. A disfagia foi tratada com dilatações esofágicas periódicas. Dois pacientes apresentando sintomas de refluxo grave foram submetidos a fundoplicatura à Nissen modificado através de videolaparoscopia, com bons resultados. CONCLUSÕES: O esôfago de Barrett nesses doentes poderia estar associado com a ingestão de cáustico, porque nem sempre esteve associado à esofagite por refluxo. É muito importante o seguimento desses doentes e realização periódica de endoscopias digestivas com biopsias do esôfago de Barrett, devido à possibilidade de malignização.<br>BACKGROUND: The esophageal stenosis secondary to the ingestion of caustic products is frequent in Brazil, mainly due to an attempt suicide. The Barrett's esophagus is consequence of the chronic gastroesophageal reflux. The literature consulted showed that are a rare association. CASUISTIC AND METHODS: From 1981 to 2000 were admitted and treated in the "Gastrocentro" State University of Campinas, SP, Brazil, 120 patients presenting caustic stenosis of the esophagus, and during the follow-up were found nine cases with Barrett's esophagus associated (7,5%). The time of caustic ingestion varied from 4 years to 54 years (mean 29 years), and they were four males and five females, eight whites and one black, with the mean age of 57,7 years (43 to 72 years). RESULTS: All the cases presented dysphagia and the flexible upper endoscopy showed stenotic areas and caustic esophagitis sequels. Three patients referred symptoms of gastroesophageal reflux, but hiatus hernia were found in only one case. The Barrett's esophagus was found in the middle third of the esophagus above the stenotic areas in three cases, and in the distal third in six cases. The dysphagia was treated with periodic esophageal dilatations. Two patients presenting severe symptoms of reflux were submitted to modified Nissen fundoplication by videolaparoscopy, with good results. CONCLUSIONS: The Barrett's esophagus in these patients could be associated to the caustic ingestion, because it is not situated in the distal third of the esophagus, as commonly found in reflux esophagitis. Its is very important the follow-up and biopsies of the Barrett's esophagus, due to the possibility of malignancy